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Klein FR, Klein J, Otalora Lozano D, Vigliano C. Late Diagnosis of Langerhans Cell Histiocytosis by Skin Biopsy in a Lung Transplant Candidate Patient. Cureus 2024; 16:e55226. [PMID: 38558685 PMCID: PMC10981517 DOI: 10.7759/cureus.55226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
We present the case of a lung transplant candidate under veno-venous membrane oxygenation assistance (VV ECMO) whose diagnosis of emphysema of undetermined etiology was redefined as Langerhans cell histiocytosis (LCH) due to a scalp skin biopsy performed years after the beginning of his respiratory symptoms. A 20-year-old patient started three years before his admission with progressive dyspnea leading to a diagnosis of bullous emphysema of undetermined cause, which evolved into respiratory failure and evaluation for bilateral lung transplant. Three years later, he developed bilateral pneumonia requiring mechanical ventilation. When refractory hypoxemia ensued, he had to be placed on VV ECMO. Under these conditions, he was transferred to our center and listed for a bilateral pulmonary transplantation. Forty-eight hours after admission, and due to intense polyuria, central diabetes insipidus was diagnosed. In this clinical context, the presence of cutaneous lesions on the scalp was reconsidered and biopsied under the presumption of possible LCH, with pathology analysis confirming the diagnosis. He continued to be assisted with VV ECMO for 66 more days as a bridge to transplantation, developing multi-organ failure and passing away before a donor organ was available. The diagnosis of LCH should be considered in any adult patient with bullous emphysema of undetermined cause. Given the possibility of early therapeutic interventions, the search for its clinical associations (e.g., diabetes insipidus and/or skin lesions) should be a systematic part of the etiologic workup. The availability of skin specimens to reach a diagnosis makes its thorough search an important part of the diagnostic approach.
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Affiliation(s)
- Francisco R Klein
- Critical Care Medicine, Favaloro University, Faculty of Medical Sciences, Buenos Aires, ARG
- Critical Care Medicine, Favaloro Foundation University Hospital, Buenos Aires, ARG
| | - Julia Klein
- Critical Care Medicine, Sheba Medical Center, Intensive Care Unit, Ramat Gan, ISR
| | - Diego Otalora Lozano
- Critical Care Medicine, Favaloro Foundation University Hospital, Buenos Aires, ARG
| | - Carlos Vigliano
- Pathology, Favaloro Foundation University Hospital, Buenos Aires, ARG
- Board of Science and Technology (Dirección de Ciencia y Técnica, DCT), Institute of Translational Medicine, Transplantation and Bioengineering (IMeTTyB) Favaloro University-National Scientific and Technical Research Council (CONICET), Buenos Aires, ARG
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2
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Heritier S, Donadieu J, Leger PL, De Tersant M, Della Vallee V, Barkaoui MA, Le Louet S, Tazi A, Taytard J, Corvol H, Helias-Rodzevicz Z, Emile JF, Fadel E, Fabre D, Feuillet S, Nathan N. Lung transplantation as a rescue option in childhood critical pulmonary Langerhans cell histiocytosis. Pediatr Pulmonol 2024; 59:192-195. [PMID: 37792300 DOI: 10.1002/ppul.26717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Sébastien Heritier
- French Reference Center for Histiocytosis, APHP, Trousseau Hospital, Sorbonne Université, Paris, France
| | - Jean Donadieu
- French Reference Center for Histiocytosis, APHP, Trousseau Hospital, Sorbonne Université, Paris, France
| | - Pierre-Louis Leger
- Intensive Care Unit, APHP, Trousseau Hospital, Sorbonne Université, Paris, France
| | - Marie De Tersant
- Department of Pediatric Hematology, Robert-Debré Hospital, Paris, France
| | - Valeria Della Vallee
- Department of Radiology, APHP, Trousseau Hospital, Sorbonne Université, Paris, France
| | - Mohamed-Aziz Barkaoui
- French Reference Center for Histiocytosis, APHP, Trousseau Hospital, Sorbonne Université, Paris, France
| | - Solenne Le Louet
- French Reference Center for Histiocytosis, APHP, Trousseau Hospital, Sorbonne Université, Paris, France
| | - Abdellatif Tazi
- French Reference Center for Histiocytosis, Saint Louis Hospital, Université de Paris, France
| | - Jessica Taytard
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases, Inserm UMR_S933, Inserm UMR_S1158, Centre de Recherche Saint Antoine, APHP, Trousseau Hospital, Sorbonne Université, Paris, France
| | - Harriet Corvol
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases, Inserm UMR_S933, Inserm UMR_S1158, Centre de Recherche Saint Antoine, APHP, Trousseau Hospital, Sorbonne Université, Paris, France
| | - Zofia Helias-Rodzevicz
- Pathology Department, EA4340-BECCOH, Assistance Publique-Hôpitaux de Paris (APHP), Ambroise-Paré Hospital, Paris-Saclay University, Versailles SQY University (UVSQ), Boulogne, France
| | - Jean-François Emile
- Pathology Department, EA4340-BECCOH, Assistance Publique-Hôpitaux de Paris (APHP), Ambroise-Paré Hospital, Paris-Saclay University, Versailles SQY University (UVSQ), Boulogne, France
| | - Elie Fadel
- Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Dominique Fabre
- Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Séverine Feuillet
- Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Nadia Nathan
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases, Inserm UMR_S933, Inserm UMR_S1158, Centre de Recherche Saint Antoine, APHP, Trousseau Hospital, Sorbonne Université, Paris, France
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3
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Bhatt R, Semple T, Slater O, Nicholson AG, Casanueva L, Desai A, Hoschtitzky A, Milne P, Langley R. Extracorporeal membrane oxygenation: Bridging therapy in paediatric pulmonary Langerhans cell histiocytosis. J Paediatr Child Health 2022; 58:906-908. [PMID: 34510623 DOI: 10.1111/jpc.15712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Reena Bhatt
- Department of Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Thomas Semple
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Olga Slater
- Department of Paediatric Oncology, Great Ormond Street Hospital, London, United Kingdom
| | - Andrew G Nicholson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Lidia Casanueva
- Department of Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Ajay Desai
- Department of Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Andreas Hoschtitzky
- Department of Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Paul Milne
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ross Langley
- Department of Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,Department of Paediatric Respiratory Medicine and Sleep Medicine, Royal Hospital for Children, Glasgow, United Kingdom
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4
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Eckstein OS, Nuchtern JG, Mallory GB, Guillerman RP, Musick MA, Barclay M, Bhatt JM, Davies P, Grundy RG, Martin A, Hilliard T, Lowis SP, Picton S, Nanduri V, Visser J, Allen CE, McClain KL. Management of severe pulmonary Langerhans cell histiocytosis in children. Pediatr Pulmonol 2020; 55:2074-2081. [PMID: 32511892 PMCID: PMC7771630 DOI: 10.1002/ppul.24822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/21/2020] [Accepted: 05/06/2020] [Indexed: 01/17/2023]
Abstract
Patients with pulmonary Langerhans cell histiocytosis (LCH) typically have a benign course but may have extensive cystic lung disease with rare life-threatening complications including multiple and recurrent pneumothoraces and respiratory failure. We report seven severely affected pediatric patients treated with chemotherapy, aggressive chest tube management, and pleurodesis of whom five survived. Patients with extraordinary amounts of pulmonary cystic disease and multiple pneumothoraces due to LCH can have remarkable, curative outcomes with early recognition, optimal LCH-directed therapy, and supportive care.
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Affiliation(s)
- Olive S Eckstein
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas.,Division of Pediatric Hematology-Oncology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Jed G Nuchtern
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas.,Michael E. DeBakey Department of Pediatric Surgery, Baylor College of Medicine, Houston, Texas
| | - George B Mallory
- Division of Pulmonology, Texas Children's Hospital, Houston, Texas
| | - R Paul Guillerman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Texas
| | - Matthew A Musick
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Mhairi Barclay
- Department of Paediatric Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Jayesh M Bhatt
- Department of Paediatric Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Patrick Davies
- Department of Paediatric Intensive Care, Nottingham University Hospitals, Nottingham, UK
| | - Richard G Grundy
- Department of Paediatric Oncology, Nottingham University Hospitals, Nottingham, UK
| | - Alice Martin
- Department of Paediatric Intensive Care, Bristol Children's Hospital, Bristol, UK
| | - Tom Hilliard
- Department of Paediatric Respiratory Medicine, Bristol Children's Hospital, Bristol, UK
| | - Stephen P Lowis
- Department of Paediatric Oncology, Bristol Royal Hospital for Children, Bristol, UK
| | - Susan Picton
- Department of Paediatric Oncology, Leeds Children's Hospital, Leeds, UK
| | - Vasanta Nanduri
- Department of Paediatrics, Watford General Hospital, Watford, UK
| | - Johannes Visser
- Department of Paediatric Oncology, Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Carl E Allen
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas.,Division of Pediatric Hematology-Oncology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Kenneth L McClain
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas.,Division of Pediatric Hematology-Oncology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
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Barclay M, Devaney R, Bhatt JM. Paediatric pulmonary Langerhans cell histiocytosis. Breathe (Sheff) 2020; 16:200003. [PMID: 32684994 PMCID: PMC7341617 DOI: 10.1183/20734735.0003-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/10/2020] [Indexed: 12/24/2022] Open
Abstract
Paediatric pulmonary Langerhans cell histiocytosis (pPLCH) is a rare diffuse cystic lung disease. Unlike pulmonary Langerhans cell histiocytosis (LCH) in adults, which is often seen as an isolated condition with smoking being a major risk factor, isolated pPLCH is vanishingly rare in children and it is most often a component of multisystem LCH. Diagnosis should be based on histological and immunophenotypic examination of affected tissue in addition to clinical and radiological features. It should be considered an important differential for diffuse cystic lung disease in paediatric patients. Recent progress in the biological understanding of the disease supports the classification of LCH as an inflammatory myeloid neoplasia. Chemotherapy and specific management of respiratory complications are the mainstays of treatment. The lungs are no longer considered a "risk organ" in LCH as pulmonary involvement is not associated with a worse prognosis than the involvement of other organs. Multidisciplinary treatment approaches are needed. Prognosis can be good but is adversely influenced by multisystem involvement, and complications such as pneumothoraces and respiratory failure can be life threatening. This review aims to give an overview of this condition, with a focus on the diagnosis, monitoring and management of complications such as pneumothoraces and respiratory failure, which can be challenging for the paediatric respiratory specialist. EDUCATIONAL AIMS To give an overview of paediatric pulmonary LCH.To discuss the differential diagnosis of paediatric cystic lung disease.
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Affiliation(s)
- Mhairi Barclay
- Paediatric Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rebecca Devaney
- Paediatric Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jayesh. M. Bhatt
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Soyer T, Özyüksel G, Türer ÖB, Çakmakkaya K, Yavuz S, Yalçın B, Orhan D, Yalçın E, Doğru D, Bayrakçı B, Kiper N, Akyüz C. Bilateral Pulmonary Langerhans's Cell Histiocytosis is Surgical Challenge in Children: A Case Report. European J Pediatr Surg Rep 2019; 7:e8-e11. [PMID: 31131184 PMCID: PMC6533102 DOI: 10.1055/s-0039-1688771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/31/2019] [Indexed: 11/07/2022] Open
Abstract
Background
Pulmonary Langerhans's cell histiocytosis (PLCH) is a rare cause of interstitial lung disease in children and more than half of the cases are bilateral. Persistent respiratory distress due to spontaneous pneumothorax (SP) in bilateral PLCH may refractory to conservative treatment and posed a great challenge to surgical modalities. A 3-year-old boy with SP due to bilateral PLCH is presented to discuss the surgical options of recurrent and refractory PLCH cases in children.
Case Report
The patient was admitted to the emergency department with severe respiratory distress and SP. After chest tube insertion, biopsy from neck mass revealed Langerhans's cell histiocytosis. Chemotherapy including vinblastine and prednisone was initiated. Due to persistent respiratory difficulty and air leaks, talc pleurodesis and thoracoscopic bullae excision with pleural decortication were performed. Two months after the admission, due to nosocomial infection and severe respiratory distress, extracorporeal membranous oxygenation (ECMO) support was initiated. The patient was died of ECMO complications on 24th day of ECMO.
Conclusion
Despite the use of chemotherapy and surgical excision of cystic lesions, bilateral PLCH in children may have lethal outcome. Other treatment options including respiratory support with ECMO and lung transplantation should be considered as last resort of treatment alternative in persistent cases.
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Affiliation(s)
- Tutku Soyer
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Gül Özyüksel
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Özlem Boybeyi Türer
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Kübra Çakmakkaya
- Department of Pediatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Sinan Yavuz
- Department of Pediatric Intensive Care, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Bilgehan Yalçın
- Department of Pediatric Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatric Pathology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatric Pulmonology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Deniz Doğru
- Department of Pediatric Pulmonology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Benan Bayrakçı
- Department of Pediatric Intensive Care, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Canan Akyüz
- Department of Pediatric Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Mesini A, Moscatelli A, Castagnola E. Pertussis vaccination in pregnancy: how many pediatric hospitalizations could be prevented? MINERVA GINECOLOGICA 2019; 71:245-248. [PMID: 31089073 DOI: 10.23736/s0026-4784.19.04378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pertussis is a severe disease in children, especially in neonates and it is preventable by vaccination during pregnancy. After the observation of a 2-month-old toddler who needed extracorporeal membrane oxygenation for severe RSV plus Bordetella pertussis infection, we performed a review of all cases of pertussis admitted at the Istituto Giannina Gaslini, Genoa, Italy, from 2012 to 2018. We retrieved 72 cases of admission for pertussis, 46% aging less than 3 months, 42% with at least one comorbidity. Two patients needed ICU admission. Pertussis vaccination during pregnancy could contribute to reduce this burden of hospitalizations in youngest subjects.
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